Training frontline staff in India: Postpartum hemorrhage Emergency Care Using a Bundle Approach (PPH EmC)

Postpartum hemorrhage (PPH) is a major maternal killer in India. When the mother dies, it is often due to various delays in seeking appropriate healthcare. Depending on the region of the world, women rarely live close to hospitals that can provide adequate support. Access to specific drugs, an ambulance system or a blood bank can make the difference between life and death. PPH has become a symbol in the fight for global health democratisation where 99% of PPH deaths occur in developing nations. FIGO works with the Massachusetts General Hospital (MGH) and in-country implementation partners to provide PPH technical and training support to select regional and national societies. Building on 10 years of innovative work to reduce PPH-related death and disability, the Massachusetts General Hospital Global Health Innovation Lab (MGH GHI) has collaborated with senior OBGYNs and maternal health champions around the world to co-create a comprehensive initiative to deliver quality PPH emergency care using a bundle approach.

Postpartum hemorrhage Emergency Care Using a Bundle Approach (PPH EmC) is a different way of conceptualizing PPH emergency response that integrates crucial clinical and systems-based interventions for rapid, effective PPH emergency care. Funded by the Bill & Melinda Gates Foundation, the PPH EmC program is an iterative process to strengthen systems of emergency obstetric care delivery.  Based on the World Health Organization (WHO) guidelines for PPH management, PPH EmC clinical interventions consist of evidence-based and cost-effective non-surgical interventions that are relatively simple to learn and perform. PPH EmC also highlights health system strengthening strategies to reduce delays and improve adherence to best practices.

 

Using the Bundle Approach, efforts to combat PPH in the Indian state of Uttar Pradesh are underway. The 6th of September 2021 marked the completion of the FIGO PPH Emergency Care by bundle approach. The pilot was composed of doctors and nurses by King George’s Medical University (KGMU) based in Uttar Pradesh.

This pilot was supervised by Prof Uma Singh, Dean and HOD, KGMU and other faculty members,  supported by the Federation of Obstetrics and Gynaecological Societies of India (FOGSI) and its lead partner Uttar Pradesh Technical University (UPTSU). This is a great achievement towards reducing maternal and newborn mortality in India, where PPH is responsible for 30% of maternal deaths. We want to thank our partners in helping us combat maternal deaths and PPH in India. With them, the fight against maternal mortality continues.

Follow us on Twitter @FIGOHQ for more updates on our progress in Uttar Pradesh.

 

FIGO and ICM launch joint statements of recommendation for the prevention and treatment of PPH

The International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM) are pleased to announce the publication of two joint statements of recommendation for the prevention and treatment of postpartum haemorrhage (PPH).

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The Joint statement of recommendation for the use of uterotonics for the prevention of postpartum haemorrhage and the Joint statement of recommendation for the use of tranexamic acid for the treatment of postpartum haemorrhage are the culmination of strong and effective collaboration between FIGO and ICM – two of the world’s leading organisations representing specialists in midwifery, obstetrics and gynaecology.

PPH remains the leading cause of maternal mortality in low-income countries and the primary cause of nearly one quarter of maternal deaths globally. The vast majority of these deaths occur in lower-middle-income countries (LMICs) and are a result of a lack of accessible, skilled medical personnel equipped with appropriate supplies, medications and training.

In publishing these joint statements, FIGO and ICM once again illustrate their commitment to effecting positive change in the health and care of women, girls and their families. FIGO President, Dr Carlos Füchtner, highlighted the importance of the recommendations and of working in collaboration and partnership.

”FIGO is proud to be working with and through our national societies, and in collaboration with ICM and national midwife associations. Together, we have developed recommendations on the treatment and management of PPH that can enhance frontline practice, strengthen the provision of care, and ultimately improve the quality of health care services for women and girls around the world – in particular in LMICs”.

ICM President, Franka Cadée, echoed Dr Füchtner’s words, drawing attention to the importance of evidence and putting women, girls and newborns at the centre of their care.

”Respectful collaboration between FIGO and ICM will contribute to a better understanding and appreciation of the complementary and equally significant roles of midwives and obstetricians within the context of preventing and managing PPH.

Operating from an evidence-based standpoint, we encourage members of both professions to leverage these guidelines in an effort to ensure medical interventions during childbirth are appropriately responsive to the context. Underpinning this collaboration and resulting recommendations is the importance of ensuring every woman has the information she needs to make informed decisions about her care, and the care of her newborn”.

For these recommendations to have maximum impact on the prevention and treatment of PPH, policy makers, practitioners and supply chain experts need to be updated on the new recommendations and have access to quality uterotonics and tranexamic acid. Speaking about the implementation of the guidelines, Dr Alison Wright, member of FIGO’s Safe Motherhood and Newborn Health Committee and PPH Working Group, said,

”I am delighted that FIGO and ICM have come together with one voice, to give clear recommendations for the prevention and treatment of PPH. As obstetricians, we look forward to working together with our midwifery colleagues to support implementation of these recommendations at a local level.

Ensuring frontline obstetricians and midwives are appropriately trained and have direct and timely access to effective uterotonics and tranexamic acid will save hundreds of thousands of lives and significantly improve the provision of safe, personalised care for all women, girls and their families worldwide”.

FIGO is proud to be heading up a project to continue the effort for the next phase – to close the gap between global evidence-based recommendations on, and the implementation of, lifesaving medicines.

With our partners ICM, Concept Foundation and MSD for Mothers through the Improving access to essential medicines to reduce postpartum haemorrhage (PPH) morbidity and mortality (IAP) project, FIGO is working to improve the adoption of these recommendations to ensure health care providers are empowered in implementing these interventions at the frontline of the health care system.

Read and download the statements, and find out more about FIGO’s IAP project, using the links above. The statements can also be found in the resource section of this website. 

Kenya: The UBT kit saves mother from postpartum hemorrhage in Migory County

When Josephine* started experiencing labor pains for their last born daughter, her husband quickly suggested that they should leave to the hospital before it was too late. Josephine’s husband shared with us the horrific experience his wife went through during her last delivery which nearly cost Josephine’s life.

Josephine is a 39 years old mother, a resident of Kamagambo in the Migori County. Josephine shared her story about her past deliveries as a mother of 8 children, 5 healthy boys and 3 healthy girls with her youngest being only four months old. In the past, Josephine had never gave birth in a hospital specialising in maternal care. During her previous antenatal care visits, she preferred being attended to by the village midwives (TBAs) until her third delivery where she bled disproportionately. On this occasion, Josephine’s husband had rushed her to the nearby health center where Josephine could receive help. Since then, her husband decided to avoid risking complications and accompanied his wife every time to give birth at the Rongo Sub County Hospital. As a result, Josephine’s following five delivery were done safely in the hospital specialising in maternal care.

However, Josephine’s last delivery did not go well. When Josephine arrived at the Rongo Sub-County Hospital, the mother was informed the baby would not arrive before the next hour. Josephine tried to pass the time by singing and strolling. Josephine was hopeful at the idea of holding her beautiful baby but unexpectedly began bleeding .

The nurse taking care of Josephine shared with us her shock and fear over losing the mother after the baby was born. The nurse mentioned it had happened to her before and she was unwilling to take any chances. The nurse recalls calling for help and using the UBT kit and NASG as an effective emergency method to treat postpartum hemorrhage.

The UBT is a medical device that can be used to treat postpartum hemorrhage when the mother is unresponsive to uterine acting drugs, evacuation or other primary intervention. The UBT kit uses a condom inserted into the uterine cavity using a catheter and then inflated with water. The balloon applies pressure to the walls of the uterus to stop excessive bleeding.

Josephine recalls: “I saw the nurse and the doctor inserting something through my vagina that I had never seen or had of before, it was in different parts but still I couldn’t tell what it was since I was unconscious. The nurse told me that I had bled a lot and somehow the bleeding had not stopped and something had to be done, at this point my husband who was very worried was asked to leave the room.

So many things crossed my mind in a minute, I thought of our situation back home , who would take care of my children if I past away. I asked God to let me live to continue seeing my children grow when they were so young and thought I was dreaming what was happening to me.’’

Josephine says she could have not imagined the children’s life without her. Her husband was a carpenter in the nearby Centre and the family’s income was not consistent enough to guarantee a better future for her children.

Story provided by KMET

*The names have been changed for anonymity